Sutures are used to approximate, or bring together, tissue separated, for example, by some trauma, or wound or during a surgical procedure to close an incision or an organ perforation. Suturing instruments generally include a needle and a trailing length of suture material. In endoscopic procedures, the instruments placed through an instrument channel may include needles and sutures for stitching such a wound, incision or perforation within the patient's body cavity. An exemplary suturing device is shown in U.S. Pat. No. 7,131,978.
Physicians have often used endoscopes to examine, to biopsy, and to ablate the tissue of patients within lumens such as the esophagus and the bowel or other body cavity and internal patient sites. An endoscope generally includes either a rigid or flexible tube containing one or more optical fiber systems and, for operative uses (human or veterinary), one or more channels for passage of medical instruments. The optical system includes a light delivery system to illuminate the organ or site under inspection and a camera system to transmit the image of the site of interest to the viewer. The light source is normally outside the body and the light is typically directed via optical fiber bundles to the area of interest. A physician performing a therapeutic procedure with the use of an endoscope places a long, flexible instrument through the endoscope's instrument channel and then positions the instrument near the site within the body cavity, lumen or other internal site of interest where a therapeutic procedure is to be performed.
A physician performing a therapeutic procedure with the use of an endoscope places a long, flexible instrument through the endoscope's instrument channel and then positions the instrument near the site within the body lumen where a procedure is to be performed. The instrument channels and optical fiber bundles open into the body at the distal end of the endoscope and are generally parallel to the axis of the flexible endoscope. Physicians place flexible instruments through the instrument channels while visualizing and illuminating an internal site using the optical fiber bundles.
More recently, a surgical technique known as natural orifice transenteric surgery (NOTES) is attracting interest. NOTES, which enables “scarless” abdominal operations, may be performed with an endoscope that is passed through a natural orifice (mouth, nose, anus, etc.), then through an internal incision in the stomach or colon, for example, thus avoiding any external incisions or scars. The NOTES technique has been used for diagnostic and therapeutic procedures in animal models, including transgastric (through the stomach) organ removal. Transcolonic approaches are also advocated for access to upper abdominal structures that may be more difficult to work with using a transgastric approach.